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This Week in NEJM: May 5, 2011

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In NEJM this week, a team of researchers in Scandinavia and the US report results from a three-year follow-up of a study comparing the effectiveness of radical prostatectomies versus watching and waiting in early prostate cancer patients. From October 1989 to February 1999, the researchers randomly assigned 695 men with early prostate cancer to "watchful waiting" or radical prostatectomy, and continued to follow-up through December 2009. During a median of 12.8 years, 166 of the 347 men in the prostatectomy group and 201 of the 348 men in the watching and waiting group died. In 55 of the men from the surgery group and 81 of the men in the watching group, the deaths were due to prostate cancer, the authors write, yielding a cumulative incidence of death from prostate cancer at 14.6 percent in the surgery group and 20.7 percent in the other group. "Radical prostatectomy was associated with a reduction in the rate of death from prostate cancer," the researchers add. "Men with extracapsular tumor growth may benefit from adjuvant local or systemic treatment."

Also in NEJM this week, Matthew Smith at Harvard Medical School asks whether effective treatment for early prostate cancer is necessary or even possible. Citing the Scandinavian study, the follow-up of which is featured in this week's NEJM, Smith says the results prove that radical prostatectomies are a necessary and possible effective treatment for early-stage prostate cancer. Recent studies of radiation therapy provide additional evidence of the importance of controlling the disease early on, he adds, and have shown that clinical outcomes are improved when adjuvant radiation therapy is given after prostatectomy. However, as all treatments have potential side effects like sexual dysfunction and incontinence, Smith says, "Management of early-stage prostate cancer will continue to require careful consideration of the severity of the disease, the potential benefits and harms of intervention, and the patient's age, health status, and individual preferences."

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